How I Chose a Treatment That Prioritized My Qualify of Life

After scheduling my first appointment with a urologist to begin the diagnostic process for prostate cancer, I started researching treatment options. I wanted to better understand what the doctor might recommend and ask informed questions.

The most common treatments available at my local hospital were surgery, external beam radiation, brachytherapy, and CyberKnife®. I had heard of these, but I didn’t know whether one was more effective than the others.

Which prostate cancer treatment is best for me?

After being diagnosed with stage T2c prostate cancer, I sought a second opinion from another urologist to determine which treatment might be best for me. His response was, “We don’t know which treatment is best for any individual patient, and we cannot predict the severity of side effects.” That was not what I wanted to hear!

I wanted a clear ranking of treatment success rates and the likelihood of side effects. After that discouraging visit, I realized I would have to decide what treatment outcome I desired. My primary goal was to minimize the chance of urinary or fecal incontinence and erectile dysfunction. My quality of life was more important to me than longevity.

Comparing the side effects of surgery and radiation

I made an appointment with a local radiation oncologist. He provided a spreadsheet comparing the available treatments and reported common side effects.

The data stated the potential side effects of surgery included:

• Urinary incontinence
• Worse sexual function compared with radiation treatments
• Better bowel and bladder function than radiation
• Shortening of the penis due to removal of the prostate and reattachment of the urethra to the bladder

All the radiation treatments carried similar side effects. These included:

• One to two months of fatigue
• Bladder irritation with frequent burning during urination
• Loose stools or diarrhea lasting up to a year
• Better sexual function than surgery
• The possibility of bowel or bladder damage

Opening myself to other treatment options

None of these options aligned with my goal of maintaining my current quality of life. The more I considered these potential side effects, the more reluctant I became to pursue any of these treatments. I had previously undergone two inguinal hernia surgeries and struggled with prolonged recovery, taking years to become pain-free. I was not eager to face an even more difficult recovery.

I also had concerns about radiation therapy, including the use of a hydrogel rectal spacer that would be inserted between the prostate and rectum to protect the rectum from radiation exposure.

Realizing I needed a fresh perspective, I called my brother, a heart surgeon, for advice. He explained that every serious medical treatment carries additional costs in the form of side effects. That was difficult to accept.

As we talked further, he suggested I explore other prostate cancer treatments available elsewhere in the United States. After months of stressing over my options and many sleepless nights, I was open to alternative modalities.

Discovering high-intensity focused ultrasound (HIFU)

Finding a different treatment option was not easy. Most hospitals offer the same standard modalities and emphasize their experienced staff. Eventually, I discovered a physician who had given a presentation on high-intensity focused ultrasound (HIFU) ablation for prostate cancer. The hospital was a five-hour drive away, but I was eager to learn more about this option.

From the urologist’s presentation, I learned that HIFU ablation is performed under anesthesia. A probe is inserted into the rectum adjacent to the prostate. It emits focused ultrasound waves that converge to generate heat — over 185°F — destroying targeted cancer cells, while sparing most non-targeted cells. This procedure involves neither surgery nor radiation. Although there is always some risk of side effects, I found they can be fewer than the side effects associated with conventional prostate cancer treatments. Also, the recovery time can be faster than with the other options.¹

Reflecting on my recovery and long-term results

I underwent HIFU ablation in May 2022. Although the procedure is generally painless and well-tolerated, temporary penile and scrotal swelling can occur, though I did not experience it.² I required a urinary catheter for two weeks.

After removal, I had difficulty passing blood clots for about three weeks and experienced dribbling incontinence for two months. Burning during urination lasted about a month but responded well to over-the-counter urinary pain relief medication. Sexual function returned within three months, with satisfying orgasms but without ejaculation, since the prostate no longer produces semen.

Now, four years after the procedure, I remain on active surveillance with my urologist. With 85% of my prostate ablated, my prostate still produces prostate-specific antigen (PSA), which is tested every six months to determine whether there are any concerning changes. I am satisfied with my decision to choose HIFU ablation, as it has met my primary goal of preserving my quality of life, and there has been no indication of cancer.